STERILE DRESSINGS—ANTISEPTIC SOLUTIONS—STERILIZATION OF INSTRUMENTS
The preparation of sterile dressings, antiseptic solutions and the sterilization of instruments, is particularly the work of the nurse, whether in the hospital or in a private home. The following directions are therefore desirable:
As soon as the nurse is sure her patient is in labor, she boils a milk bottle, fills it two-thirds full of 95 per cent alcohol, puts a pledget of sterile cotton in the bottom and then boils a pair of dressing forceps, which are placed, handle up, in the alcohol. (See Fig. 52, page [132].) With this forceps, she handles all clean dressings, instruments, and rubber goods that may be contaminated by touch.
Dressings and Supplies.—The necessary dressings and supplies may be prepared one or two weeks before labor according to the following instructions:
Five Yard Packing.—Draw threads at either end of five yard lengths of gauze to its full width. Fold the cut edge across until it lies one-third the distance from the opposite side. Next, fold the double edge over, and bring it to the outside edge of the first fold. Keep it perfectly straight. When folded full length, roll from the end and wrap in strong muslin wrappers. Sterilize in the autoclave or Arnold sterilizer.
Pads for the Vulva.—Unroll a whole bale of common cotton and cover it with a ½ inch thickness of absorbent cotton. Cut in lengths of 12 in. by 4 in. wide. Cover with gauze cut 12 by 14 inches, and fold the ends of gauze over absorbent cotton. Roll from the end, wrap in paper, seal, and sterilize.
Pledgets.—Tear two yard strips, lengthwise of the roll of absorbent cotton, pull from these, three inch pieces, roll them in the hands until round, place in clean bags, and sterilize.
Breast Covers.—Squares of old, soft muslin 4 by 4 inches, with all strings removed, make the best dressings for the nipple. Do not use gauze, because the papillæ of the nipple may get caught in the mesh and when it is taken off, the tender nipple is irritated or abraded.
Breast Binders.—These are made of single material, because they would be too warm otherwise. They are sleeveless and jacket-shaped and measure 16 inches from shoulder to waist, 40 inches long, and 10 inches for the arm scallop. A binder of this size, if properly adjusted, will fit a patient of any size. Three will be sufficient for the case.
Abdominal Binders.—The abdominal and breast binders are worn during the bed period only. The abdominal binder is made of unbleached muslin, double material, 14 by 40 inches, and hemmed. In the center of the back, on the lower edge, a curved space, six inches wide, is cut out to prevent the binder from getting soiled. To this curved edge, the pad holder is attached by two safety pins, one on either side. The abdominal binder is adjusted by pinning firmly above the fundus, and loosely below.
Pad holders are made of unbleached muslin, and measure 6 by 16 inches.
Cord Dressings.—Cut squares of surgical lint 4 by 4 inches, and cut through to the center on one side. Gauze may be used, but it is not ideal.
Nursery Cotton.—Tear absorbent cotton into narrow lengths and pull out small one inch pieces. Roll them, place in a clean bag and sterilize.
Applicators.—Use absorbent cotton and toothpicks. Tear off small pieces of cotton, moisten the toothpick point with water, place in the middle of the cotton, and roll firmly.
Gauze Sponges.—Cut gauze into squares 6 by 6 inches, and fold from each side to the center. This brings all the ragged edges inside. Fold into squares, place in jars, and sterilize.
Sterilization of Instruments.—Place scalpels in carbolic acid 95 per cent for ten minutes. Lift with sterile forceps, and put in a basin of 95 per cent alcohol for ten minutes. In the absence of carbolic acid and alcohol, the scalpels may be dropped in a 2 per cent solution of lysol for twenty minutes. Cleanse with hot sterile water. (Do not boil scalpels; it dulls the sharp edges.)
All other instruments may be placed in a sterilizer (dishpan or wash boiler) with enough water to completely cover them; boil twenty minutes. Cool in sterile pan, which may be set in cold water. Do not use soda on the instruments during sterilization, as it makes a thick, gummy precipitate on the metal.
The sterile handling forceps must be immersed at all times for two-thirds their length in 95 per cent alcohol.
Brushes.—After using, all brushes should be thoroughly washed, boiled, and dried, wrapped in waxed papers, and sterilized in the autoclave. In the absence of the autoclave, boil thirty minutes.
Basins, pitchers, and douche pans are sterilized by wrapping in strong muslin bags and put to boil for forty-five minutes in the basin boiler or wash boiler. They will not remain sterile longer than one week, even when kept in a clean place and well wrapped. Bedpans should be washed in a strong solution of soap and water, rinsed every morning and boiled for thirty minutes.
Sterilization of Rubber Goods.—
Tracheal Catheters.—Drop in a solution of bichloride 1:5000 and leave for twenty minutes. Lift with sterile forceps into a basin of warm sterile water and leave for ten minutes, or until used.
Vorhees Bags.—Boil twenty minutes. The bags and catheters may be given a longer life by keeping them in a 25 per cent solution of glycerine and water when not in use. Kerosene vapor is also preservative.
Rubber Catheter.—Boil twenty minutes.
Hot Water Bags, Ice Caps, Rubber Bed Rings.—Soak in 10 per cent lysol solution for two hours, wash with warm water, and dry thoroughly. The inside of the ice caps can be dusted with powder.
Never leave rubber gloves in a damp place or lying in a solution. It stretches them and weakens the rubber. To sterilize, they must be washed in a strong solution of soap and water, dried, and paired. Then they are wrapped in a heavy cloth covering and put in the autoclave for twenty minutes.
Wet Process for Rubber Gloves.—Wrap in gauze or cloth and boil for thirty minutes. Lift with sterile forceps and place in lysol solution 1 per cent until used. They are easily drawn on by filling them with the solution as the hand goes in.
The autoclave is not always available, but an Arnold or Rochester sterilizer is readily portable, and takes the place of the hospital machine.
Fumigation of rooms is sometimes necessary. Remove all curtains, bed linen, and other washable fabrics from the room. Open the drawers of dressers, doors of closets, and loosen up and separate everything left so the air can get to it. Close the windows and seal the crevices with cotton and make the room as air-tight as possible. Place a large pan containing six ounces of potassium permanganate crystals in the center of the room. Pour over this twelve ounces of formalin, close and seal the outside doors of the room and leave for twelve hours. If the case has been a very septic one, it is always a good plan to wash the walls of the room before using again. The insides of the drawers and the bed should be thoroughly washed with water and green soap. A formaldehyde lamp is also quite satisfactory if obtainable.
CHAPTER XXIV
DIETS AND FORMULÆ
The nurse should serve everything in the most cleanly and appetizing way if it is only a cup of tea; and all waste, soiled dishes, napkins, and excreta must be removed as delicately as possible.
Diet for Pregnancy.—Fresh fish, boiled, broiled or baked; and shell-fish raw or cooked,—any way but fried.
Meat, once or twice a day, except when contraindicated by condition of the kidneys. Veal is best omitted.
All farinaceous foods and vegetables may be eaten freely.
Desserts should be plain, but tempting.
No alcohol is taken without direct permission from the doctor, and coffee and tea should be limited.
Diet for Puerperium.—First two days, milk, buttermilk, soup, gruel, cocoa, toast and tea, chicken, oyster and clam broth.
In the next two days, under ordinary conditions, the diet is increased and made somewhat heavier.
Semisolids are added like milk-toast, eggs, poached or boiled soft, oysters, clams and boiled fish.
After the milk comes in, the woman is put on a general diet as fast as she can digest it.
Farinaceous diet—melons and oranges.—
Breakfast.—Cereal, coffee with milk and sugar, if desired, bread and butter, corn bread, rolls, toast, muffins, hominy, cereal with cream.
Lunch.—Vegetable soups, bread, butter, potatoes, beans, rice, macaroni and cereal, peas, buttermilk, pudding, such as rice, tapioca, bread cornstarch, jellies, fruit juices, pumpkin, squash, turnips, tomatoes, etc.
Dinner.—Bread, butter, milk-toast, hominy, rice, celery, fruit salads, lettuce, apples, pears, prunes, stewed fruits or fresh melons, etc.
The following diets are routine at many hospitals:
General Diet.—Full tray of food in season as furnished by the hospital. Three meals daily.
Light Diet.—Foods from the following list may be selected, and served three or five times daily, as desired:
Soups of all kinds. When leguminous foods are employed, their outer coverings must be removed by rubbing them through a sieve or colander.
Vegetables of all kinds, except green vegetables (provided they have been reduced to a pasty consistency). Those with excess of fiber or cellulose, such as turnips, celery, asparagus, and cabbage, should be chopped after thorough boiling, then mashed, while those having tunics should be sieved or colandered.
Grain foods of all kinds thoroughly cooked, excepting corn preparations containing much cover, as hulled corn.
Prepared foods such as tapioca, macaroni, and vermicelli, require prolonged cooking.
Meats, scraped beef.
Eggs, soft boiled, raw or soft poached.
Bread of all kinds, stale, home-made.
Puddings, ices.
Beverages, all kinds unless otherwise ordered.
Forced Diet.—This includes the general diet with the addition of one quart of whole milk and four eggs. The milk may be given plain or as an eggnog at seven, ten, three, and eight o’clock. The eggs may be given raw or cooked soft in any form.
Milk Diet.—Twelve ounces of whole milk (375 c.c.) may be given every two hours; i. e., at six, eight, ten, twelve, two, four, five, and eight o’clock, or the patient may sip it at her pleasure.
The milk may be given raw, boiled, diluted with plain water, lime water, Vichy, seltzer, or Apollinaris to taste. The daily amount should include three quarts of whole milk. Koumiss, buttermilk and milk soups are sometimes allowed. Note the exact amount taken, and give reasons for failure. Watch the stools for undigested milk.
Liquid Diet.—Whole milk, buttermilk, koumiss, beef tea, or beef, chicken, mutton, oyster, or clam broth, in eight ounce portions, or two ounces of beef juice, every two hours. Lemonade, orangeade, ice cream, or fruit ices, at intervals and amounts as desired.
Ulcer Diet.—Whole milk and cream, equal parts, three ounces every two hours. Sodium bicarbonate, thirty grains, in a small amount of water, to be given before and thirty minutes after feeding. Albumin water, soft boiled eggs, scraped beef, custard, and cream soups to be added later by direction of the physician. No seasoning except salt is allowed.
Prochownik Diet.—This diet is advised where some necessity exists for preventing a large child. It is administered in the last six weeks of pregnancy only.
Breakfast.—Small cup of coffee, two slices of toast (1 ounce).
Lunch.—Small piece of meat, fish or an egg, a little sauce. A vegetable prepared with fat, lettuce, a small piece of cheese.
Dinner.—Same as lunch with three slices of bread and butter, and a little milk.
A pint of water daily is allowed; taken in sips it lasts longer.
Soup, water, beer (all fluids) and sugar, pastry, and potatoes are forbidden.
Skimmed Milk Diet (Karell).—Skimmed milk, to which a pinch of salt is added, 3 to 6 ounces, three or four times daily, increasing the amount gradually, taken slowly to allow thorough mixture with saliva, warmed in winter, room temperature in summer.
Acute Nephritis Diet.—Whole milk, 1000 c.c.; cream, 250 c.c.; water, 150 c.c.; stewed fruit, well sweetened, 50 c.c.
Bread, well buttered, may be toasted, 150 gm. (equal to three slices).
Green salad of lettuce, celery, apple, pear or grape fruit, and served either with olive oil, or with a mayonnaise dressing made from olive oil, egg and lemon juice, with salt (but no pepper or condiments) may be given in two small portions daily.
Cooked cereals (cream of wheat, etc.) with cream and sugar, one portion equal to about two ounces, once daily.
The above represents a daily fluid intake of about 1500 c.c. The diet is to be given in “three meals,” at eight, one, and six o’clock, with fluid nourishment at eleven, three, and nine o’clock.